Compelling commentary on children's health

Good Lord, what a week I’ve had. Unfortunately I can’t blog about it. My apologies for being a bit derelict in getting the word out – I’ll be on it next time. This week marked the 10 year anniversary of the blog. Look for a nice piece in this morning’s Wall Street Journal detailing the impact of blogging on the world.

Lot's of interesting stuff this week. Let's get started.

Circumcision, Quality of Life and Other Heady Stuff
By the looks of Unintelligent Design it appears that size really does matter. Clark has a lengthy submission covering the in’s and out’s of circumcision. This is remarkably well done and I might suggest that he format this a wee bit differently and make this available for public consumption. That’s just a tip, of course (no pun intended).

If you have a few extra hours and pot of coffee head over to The Preemie Experiment. Stacy drops the question of what constitutes QOL and then suggests that we talk amongst ourselves. And you could have made a full time job following this conversation. I like Teriw/2 and her Catholic angle. Our Neonatal Doc stirs things up a little bit with You II by putting in his two cents on when to resuscitate. It’s interesting to see how outcomes data can make us discriminate based on socioeconomic grounds. Heady stuff.

Dr. Kristy McNealy at NICU 101 is new to me. Read Preemies Feel Pain. More compelling than her interesting discussion of preemie pain is her posting style: remarkably well written, brief and broken into bite-size paragraphs. We could all learn something by checking this out. Nice blog, Kristy. Some personal insight on sensory issues can be found at Unique But Not Alone. I loved Hope posted at Tiggers Don’t Jump. How we communicate potentially ominous news when it isn’t certain is always sticky.

Cholesterol, True Confessions and Nutty Mothers
Dr. Rob discusses the dilemma that we all face when checking cholesterol in children. He offers his two cents from the perspective of someone who treats both adults and kids. You’ll note that the AAP has withdrawn their fuzzy position on screening the world and the AHA has a recent position paper – both are linked and required reading.

I’m absolutely convinced that over the past year Dr. Gwenn has grown progressively more hip! For example, love this discussion from the category of stupid parent tricks: Hiring a parenting consultant. This is my kind of post: amusing, light, while reflective of a frightening trend. Speaking of frightening trends you can check out my post on mothers of kids with peanut allergy who have gone a little far.

Googlevax, Smoking and Infectious Paranoia
For a little fun you can visit Shinga at Breath Spa. She revisits the issue of an anti-vaccine bias in Google searches originally posted at Medgadget. The breakdown is discouraging but well presented and easy-to-read. Speaking of wacked out antivax “researchers,” Respectful Insolence covers the latest on Andrew Wakefield. Interesting to note that this guy was paid by the attorneys (Not Insolence, Wakefield). Island of Doubt covers the suspect link between vitamin D and autism.

Med Journal Watch has an interesting series reviewing the dangers of second hand smoke. Unfortunately missing: excessive infant crying and acid reflux. And I thought this went out in eighties: HIV+ toddler evicted from pool. Tara’s quick synopsis is an alarming eye-opener. Dr. J posts on hand-foot-mouth and the social paranoia that ensues with the appearance of those little red spots. It seems the more we know, the more things stay the same.

Thanks to Clark for reminding everyone when I didn’t. And Shinga, as always, pointed out seminal posts that I’ve yet to add to Google Reader. I will add that I unfortunately had to leave out some submissions that promoted products available on the posting site. I'm not sure that we have a host for the next grand rounds so be sure to sign up - Everyone has to pitch in to make PGR great.

Check out this piece written by a mother in Des Moines. In her quest to advocate for her peanut allergic child she’s supporting the removal of all nut products from schools. Not a bad undertaking I’ll admit but when you read on it’s clear that she’s taken allergic advocacy to a new level. Every peanut butter sandwich is, after all, “like a gun pointed at every child with this disability.”

I’ll have to admit that the world has gone a little peanut crazy. Just today I evaluated a three-year-old in my office and he happened to be grazing on a bag of trail mix. When a peanut accidentally dropped to the floor the mother pounced suggesting that it could kill if it fell into the wrong little hands.

I’ve always said that the The Wall Street Journal does a great job covering children’s health issues. Thomas Burton and Shelly Banjo ran a nice piece this week on Allen Tower, founder of a little company by the name of NuMED. If you have a child with serious congenital heart disease a NuMED product may very well have touched your child. They produce some of the catheter devices that are used to treat complicated heart disease in children. Catheters, among other things, are used to stretch small vessels or insert stents to make congenitally small areas of vessels bigger. These devices are also used to block aberrant arteries and veins that are creating problems. In many cases these appliances are made to order by courageous interventional pediatric cardiologists because heart disease in babies often requires tailor-made creativity.

It seems this is the problem.

In many cases such unique appliances are so custom and so unique that achieving FDA approval is impossible. With so few children with a given problem it’s impossible to create studies with the numbers necessary to prove to The Feds that they’re safe and effective. In these cases we’ve always depended on the judgment of pediatric cardiologists to decide what’s in the best interest of a critically ill baby. And Mr. Tower and NuMED have been there to provide the tools for what needs to be done. He’s unfortunately the subject of a criminal investigation currently being conducted by the FDA. It seems they have concerns about his custom development of heart appliances in kids. If the government successful, the criminalization of NuMED could eliminate a resource that our country’s best pediatric cardiologists are dependent upon.

The testimony of interventional pediatric cardiology luminaries such as Dr. Chuck Mullins of Texas Children’s Hospital in Houston and Dr. James Lock of Boston Children’s Hospital should serve as evidence enough that NuMEDs unique services should be allowed to flourish. This is one more case where the government just doesn’t know more than the doctors caring for the kids.

If you’re having a hard time getting your child to take sugary cereal, you might want to check out Kellogg’s new Froot Loop Straws. This brilliant innovation in food science is apparently targeted to the terminally picky child fixated on things like fresh cut fruit and oatmeal. Children first experiment by nibbling. They get hooked on the fruity, crunchy sensation and soon enough they’re begging for a bowl of the real thing. Brilliant.

If you’ve never experienced life firsthand in a neonatal intensive care unit you might want to read Chris Colin’s recent piece in the San Francisco Chronicle. His account on the inside of UCSF’s intensive care nursery offers a unique view of the neonatal intensive care nursing culture. As someone who has spent my career in and out of these units I have found these women (and men in many cases) remarkable. He does a great job of capturing the casual intensity that seems to characterize the best of them (take note of his airplane theory).

If you’ve lived in a NICU you’ll unfortunately find this all too familiar.

Note to self: Tell Chris that this could be cultivated as a killer book concept.